Population patterns and trends for stroke are changing. After many years of steady and substantial decline in stroke mortality, the mortality rates have now leveled and may even be increasing regionally and nationally. This unfavorable trend may be related to poorer detection and control of hypertension or other factors. We are also entering a period of change in the medical care of stroke including new treatment methods and new systems of health care delivery which may change stroke outcomes. At this time of dynamic change in stroke, there are few centers working to document secular trends and provide data to inform clinicians and public health authorities about the burden of stroke in our nation. The Minnesota Stroke Survey (MSS) has sought to provide population-based information in the past and now seeks to continue and enhance that effort. We propose to survey hospitalized stroke among 30-84 year old residents of the Minneapolis-t. Paul metropolitan area (population 2.45 million, 1995 estimate) in the years 2000 and 2001. A 5037O random sample of discharges with target ICD stroke codes will be selected from each hospital in the survey area, records will be abstracted by trained nurses, and stroke cases will be systematically validated and classified. Stroke incidence, severity, case-fatality, and acute care in 2000-2001 will be compared to similar data from previously identified cohorts of hospitalized stroke patients, including a well-characterized cohort from 1995. To study factors influencing long-term outcomes after stroke and to characterize contemporary outpatient care of stroke, we propose to follow newly diagnosed stroke cases in one of the largest Health Maintenance Organizations (HMO) in the survey area. Beginning in January 1, 2001 and through December 31, 2002, new stroke cases in the HMO population will be identified on an ongoing basis and followed for 12 months (estimated N= 850). In-person interviews with the patient (or a proxy) and a care-giver will be conducted at 2 months and 12 months after the event to identify factors that influence changes in functional status and quality of life during recovery from stroke.